Loss and profound intellectual disabilities: the significance of early separation responses

Purpose Intellectual disabilities (ID) may complicate the experience of bereavement and loss, in those with communicative impairments compounded by complex healthcare needs and sensori-motor limitations. Whilst theorists have argued that the cognitive difficulties of people with profound ID impede mourning reactions, none have attempted to make sense of the responses they do exhibit. The current paper discusses this. Design/methodology/approach A select review considers the neurobiology underlying attachment bonds, complications in attachment formation and affect regulation in people with ID, and separation responses of people with profound ID. Findings The current paper demonstrates that by recognising the affective nature of separation distress, an understanding beyond a cognitive conceptualisation is possible. Research limitations/implications It is worth questioning whether people with profound ID are incapable of any meaningful form of person permanence. A critical review could deal with this comparatively by drawing on research of person and object permanence in typically developing children. Practical implications Of specific interest, the bio-behavioural regulators of relationships may help us to appreciate the importance of routine physical health and social care for emotional wellbeing in this group. Originality/value It is argued that by appreciating the basic emotional and regulatory functions of relationships, we can achieve a greater insight into the loss experiences of people with profound ID that will offer therapeutic direction.